Healthcare Provider Details

I. General information

NPI: 1215087564
Provider Name (Legal Business Name): SPINE SURGERY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 GUNBARREL RD
CHATTANOOGA TN
37421-3127
US

IV. Provider business mailing address

1736 GUNBARREL ROAD
CHATTANOOGA TN
37421-3127
US

V. Phone/Fax

Practice location:
  • Phone: 423-756-6623
  • Fax: 423-531-9403
Mailing address:
  • Phone: 423-756-6623
  • Fax: 423-531-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JEANNE H WEAVER
Title or Position: OFFICE MANAGER
Credential:
Phone: 423-756-6623